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D M R 29
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Front
Physical Examination
1.
Name of applicant margunet Fay
3
Address 126 Rogers are City Bioalelyn State n.y.
at
26-
2. Age
Height
6H inches Weight 135 lbs
3. General physique
good
ga
4. Tendency to disease, inherited or otherwise
negative -
+
5. Previous history in regard to serious illness or surgical operation
1912- appendectomy
no
6. Has she had rheumatism?
or
7. Has she at present or has she ever had hernia ?
negatur
8. Condition of teeth.
good
9. Condition of feet
good.
10.
Abdomen and contained organs negative - appendix renoral
11. Chest and contained organs. negative
Girth; expiration
34 / 2
inches; inspiration
37% 1
inches
Respiration, rate of
18 -
Heart, 70- -
pulse rate
Right eye (Snellen) not used
; corrected
to normal
lens used
12. Vision:
Left eye (Snellen)
corrected normal
;
to
;
lens used
13. Hearing: A. D.
15/15
A. S.
15/15
14. Urine examination:
ambar
acid
Color
Reaction
Specific gravity
1023
Albumen
negatur
Casts
negatur
Leucocytes negative.
Sugar
negative
15. Do you recommend applicant for :
OK
(a) General hospital service yes
CHS
(b) Tropical service
no.
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:
Army base hospital
that
Naval base hospital
Emergency detachment
Navy detachment
Hospital unit
starime
2
M. D.
Address 439 state St.
Date All questions MUST be
answered; otherwise certificate will not be accepted at head-
5
quarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross
Nursing Service.
(SEE OTHER SIDE)
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- Type
- photo
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Document data
- ID
- 2661450
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "D M R 29\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nFront\nPhysical Examination\n1.\nName of applicant margunet Fay\n3\nAddress 126 Rogers are City Bioalelyn State n.y.\nat\n26-\n2. Age\nHeight\n6H inches Weight 135 lbs\n3. General physique\ngood\nga\n4. Tendency to disease, inherited or otherwise\nnegative -\n+\n5. Previous history in regard to serious illness or surgical operation\n1912- appendectomy\nno\n6. Has she had rheumatism?\nor\n7. Has she at present or has she ever had hernia ?\nnegatur\n8. Condition of teeth.\ngood\n9. Condition of feet\ngood.\n10.\nAbdomen and contained organs negative - appendix renoral\n11. Chest and contained organs. negative\nGirth; expiration\n34 / 2\ninches; inspiration\n37% 1\ninches\nRespiration, rate of\n18 -\nHeart, 70- -\npulse rate\nRight eye (Snellen) not used\n; corrected\nto normal\nlens used\n12. Vision:\nLeft eye (Snellen)\ncorrected normal\n;\nto\n;\nlens used\n13. Hearing: A. D.\n15/15\nA. S.\n15/15\n14. Urine examination:\nambar\nacid\nColor\nReaction\nSpecific gravity\n1023\nAlbumen\nnegatur\nCasts\nnegatur\nLeucocytes negative.\nSugar\nnegative\n15. Do you recommend applicant for :\nOK\n(a) General hospital service yes\nCHS\n(b) Tropical service\nno.\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nthat\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nstarime\n2\nM. D.\nAddress 439 state St.\nDate All questions MUST be\nanswered; otherwise certificate will not be accepted at head-\n5\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
}